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' < ll*»H lu AlTl lc\ i U >N NO n:iuoo roNO^^>.V|KAC'Ta\U • AC.I ciNi u>40S9 ^Jjwrtbttiion IOCLJQ ARairrtrr Cj «WTIUCrOR*«'*> Iht a«tir«(, * ',!*" *“* *>•» •>««' w«.i I.. .h.ch “7:"“'<J ftom ,h, o,^,, »‘*rn>»m »rie-<‘*1 •»>-. .urt,„,nnCATE FOR payment <br />iliiirrt —-- <br />t rr*“^r ^ - p»«r « <br />- <*- AM.H rsT dm :mn <br />***>r;«A mk,/ <br />~TW AatHJWTdrrJ^'rT' .. _ <br />rniT- •“•^t .4 <br />I i 1 1 til ■ Ii M S>< *l«tiJ4 • 4. i Ot Uttwl155& ^€mn Rotd South CryMAl Bay. SIN 5SS2S .1 Ic Utt • . .1 • •»•I Vi >FROMCdNmuCTOR:OONIKACT FOIL Nailoiial Aulomalk: Sprinkler vuARairrECT:Oruflu « a; f i jlt/|*olk« RJlil Tuhlic Wuiks aulldlfigboAxinan Kf oo» rfitier r/2Notih.Vcoiicl5ifrri Miriitra|)olis. MN S540I AJriJi^llON NO : riHioi) ro. i‘ko|K:r NO:(iJNiRAfri i)Ai>:<0S9 IhMttbmloii IOC f~| OWNtllI I Anr.iiri tc*^ i I rriKnucroR. *CONTRACTOR'S APPLICATION FOR PAYMENTAppUcsilon It mtde lof ftynicm, tt thown below. In connection with the Ikmiiaci CVtnilntuiion Sheet, AIA Doctiment G70S, It tiutched.I ORICINAI OONT1IACTSUMNet change by Change Oidera.16,590.006,71800CONTRACT SUM TO DATE aJne IAS).TOTAL OOMTUmO A STORED TO DATE 53,308 0053,308.00RETAMACE:A of Cunifilctcd Wotk(Column D A E on C70S)oTStoicd Maieiial(Cohan r on C7v\*.Total Reialnage (Une fta A Sh oc <br />Total la Cohann lorc70S)**•4^ »»•«»•« ♦♦••••« •♦•ft* <br />TOTAL EARNED LESS RETAINACE.................... <br />(LlMtleatUnebTotal) <br />LESS mVKHS CERTIFICATES FOR PAYMENT <br />(Line • front prior CertlAcate) <br />53,308.00 <br />53.170.00 <br />CURRENT PAYMENT DUE • ••••••• AftAAo o« »M ••#•• ••»•«•»•#•«••• 4«ga #•»• <br />RALANdTOFINUa PLUS RETAINACE <br />(Une S lata Une A) <br />mxRcr <br />&\m%t apptqecd in <br />lottihtbf owner <br />ADDITK^NS <br />tlCEZlTXZiZ?e Ordert <br />DEDUCTIONS <br />l-‘S5or)Thf UMiicrhignciJ CormaiTur ccnifics itui ui ihp hrsi o( ihe CaFniractnr s knou^^jgp, information and bclirf ihr Work c«nrird by tliit Appluaiioii for Payment hat been comjjleied in accordance with the Contract l>»>cumenti. that all amounts have been paid by the Comractor for Work f«»r wlikh previous C^riincaiesfor Payment -ere Issued and payments received horn the Owner, and that current payment sftown herein it now JueCONTRACTOR: Naliunal Aulumeik Sprinkler Date:State of:County of;Subsiribed and iwurn to before mw this day olNotary Public:My Commission eitpires <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In at cor dance tsdih dte Contract IkAcunieriis. based on on wie observations and the <br />dsu comprising the above application, the Architect ceriines to the Owner that lo the <br />beM of the Archliecrt kimwledge. ijifoimaiiori ami belief die Work .‘ua progressed at <br />indicated, tlie <|uality of the Woik is in accordance tviih the Contract Documenri. and <br />the Coniraciof Is entitled to payment of the AMOUNT CKHTinEn <br />AMoiTN-r cEimntD <br />(AUatk mp/oPEarian •/ mmmtnt tmitfitd dtff§n fttm tkt mwuni mfftmlJm. hut*^ <br />mtlfigum ftn lk$i Apfin^ton and ifir ik* Cdmltnuatum lAal mt dkangid !• <br />$0 iht mm^uni tmttfml) <br />ARidimcr <br />Date. <br />This Certifeate is not negoriabie The AAIOUNI Cl: KTIKU t> is payabk only to the <br />(^miracior named herein IssAiame. paymetic and aiceptaacc ui paynsciit arc wttfHPUi <br />piejudice to any righuof tlie Owner 01 Camiiarior under this Conn at l <br />sssT-nrirraNs •AfPUCaTKMaMiCtRTincATt K>t PaYMtKrMWt i(>rTKJW*AUMS«nHt aherhan iNrrmrn or AiQtrrtcTv nss Ntw YURa AViwuf nw <br />HAfidffQTQlit ItC. lOOM IJtl • WAJWriWCi UantftftMa fa**««»p|4ftf •WWisb us . c«yfti|ag !■»• aaS «rSI uw «i»4al«« to b^al cm itwi <br />___;_-L.